The French surgeon Alexis Carrell is considered by many to be the father of modern vascular surgery. Indeed, many of the same vascular techniques that are in use today were developed and performed by Dr. Carrell more than one hundred years ago. His particular area of expertise related to the performance of surgical grafts and the reconnecting of arteries and veins, and his contributions in this field led to his receipt of the Nobel Prize in 1912.
As some of his early work, Dr. Carrell was able to show that by suturing two cut ends of vasculature together, the integrity of the vessel could be re-established. Laminar flow within the vessel could then be re-established. These discoveries led to microvascular surgery within the United States increasing in popularity over the last half-century.
Harry J. Buncke was particularly influential in the emergence of microvascular surgery and his work—as well as the work of others who helped popularize microvascular surgery—was effectively an offshoot of the early work of Dr. Carrell. Dr. Buncke's work centered primarily on tissue transplantation and replantation of amputated parts, although microsurgery has now expanded into numerous medical specialties. Neurosurgery, ophthalmology, and cardiac surgery all now employ microvascular techniques that are largely derivatives of the early work by Dr. Carrell and Dr. Buncke.
The work of Dr. Carrell and Dr. Buncke, among others, led early microsurgeons to focus on the development of suture materials and techniques to allow the successful performance of an end-to-end anastomosis on vessels in the range of about one to four millimeters in outer diameter. As an outcome of these developments, current surgical techniques commonly involve suturing ends of vasculature together and making use of ultrafine nylon suture. Needles in the range of about fifty to one-hundred fifty microns in diameter are used to secure the ultrafine nylon suture in place. Because of the delicacy of the vasculature and the miniaturized size of the suture and needles, intraoperative magnification is also typically required for the successful completion of an end-to-end anastomosis.
Despite rapid changes in medical technology, current techniques for a micro-arterial, end-to-end anastomosis continue to this day to primarily involve the manual suturing of two cut ends of vasculature. Because of the small size of arteries being connected, a suturing process may be very expensive as even the most skilled surgeon may require a half hour or more to complete the anastomosis procedure, even with the help of expensive, complex microscopes.
Manual suturing of vasculature in an end-to-end anastomosis is not without risk. By suturing the vessel walls together, threads are generally exposed to the blood flow inside the vessel. The thread may react with the blood cells and cause or contribute to clotting. As clotting continues, the thread may contribute to possible thrombosis. Further, in some cases, a surgeon may thread sutures through both sides of the artery, thereby effectively sewing the artery shut in the process.
Various apparatuses have been suggested for connecting vasculature in anastomosis procedures, and possibly without the need to directly suture two vessels together. For example, U.S. Pat. No. 7,192,400 issued to Campbell et al., the publication “Experimental study of mechanical microvascular anastomosis with new biodegradable ring device” published by S. Joji et al. in the British Journal of Plastic Surgery, and the publication “GEM Microvascular Anastomatic Coupler Device and System” published by Synovis MicroCompanies Alliance, Inc. describe devices and techniques in which a vessel wall is stretched over various fixed pins on a coupling ring. Such devices and techniques are typically used for veins rather than arteries, due to the elasticity of the arteries. Other techniques that have been suggested include stapling techniques, extraluminal cuffing techniques, VCS clip application, and graft connectors.
Once two ends of a vessel are attached in an end-to-end anastomosis, it is generally desired that the vessel remain attached so that blood may begin to recirculate through the affected vasculature. Accordingly, devices, apparatus, and methods for performing an anastomosis and facilitating sealing would be considered useful.